Provider Demographics
NPI:1891410536
Name:SMITH, AMANDA LUANNE (AAS; LPN DEGREE)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LUANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:AAS; LPN DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5640 S SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-4960
Mailing Address - Country:US
Mailing Address - Phone:158-088-9008
Mailing Address - Fax:580-436-5824
Practice Address - Street 1:1000 ROLLING HILLS LN
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-9415
Practice Address - Country:US
Practice Address - Phone:158-027-2241
Practice Address - Fax:580-436-5824
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator